Supervised Delivery

Management of labour and delivery is an important component of Safe-Motherhood programme and ensuring skilled attendance is the key to reducing Maternal Morbidity and Mortality.  With best ANC screening, most deliveries can be conducted with minimum or without any form of complications that will require urgent intervention. Supervised delivery also ensures that there is well preparedness and complication readiness to reduce delays in seeking assistance by the pregnant woman. Total deliveries for the year 2016 were 67,075 scoring coverage of 63.30% as against 67,771 with coverage of (65.4%) for the year 2015. Contribution towards the achievement of this service was through the effort of the following agencies GHS, Faith Based, GRMA, Quasi and Private Hospitals. Although TTBAs conducted 4,646 deliveries, yet they were not added because they did not weigh the babies at birth.

       

Table 6.4: Trend of Supervised delivery Coverage (2012 - 2016)

Indicator

2012

2013

2014

2015

2016

SKILLED DEL

66,077

64335

72190

67771

67075

68.30%

86.70%

69.54%

65.4%

63.30%

LOW BIRTH WEIGHT

6,352

6863

6,242

6122

6066

9.60%

10%10%

9.6%

9%

9%

STILL BIRTH

1,415

1287

1241

1166

1,032

2.10%1.80%

1.80%

1.7%1.80%

1.7%

1.50%

Tr. TBAs DELIVERIES

3,422

5275

4,755

5370

4646

5.10%

8.27%

4.7%

8.3%

6.92%

 

                     

 

1.1.1Essential Obstetric Care (EOC)

Basic Essential Obstetric care calls for the minimum package of services provided at the health centres without the need for an operating theatre to manage complications during pregnancy and child birth. The package includes:

  • IV/IM antibiotics administration
  • IV/IM anticonvulsants administration
  • Manual removal of placenta
  • Assisted vaginal delivery
  • Removal of retained products

On the other hand Comprehensive Essential Obstetric Care (CEOC) includes all the basic essential obstetric care services plus the availability of caesarean section and safe blood transfusion. The number of C/S recorded for the period was 10,537 (16.1%) as against 10043 (15.8%) for the year 2015. Vacuum delivery recorded 269 (0.41%); forceps recorded 9 (0.01%)

 

Causes of C/S included the following;

  • Previous C/S                                      
  • Cervical dystocia                               
  • Foetal Distress                                   
  • Cephalopelvic disproportion              
  • Delayed second stage            
  • Malpresentation                                 
  • Prolong labour
  • Antepatum Haemorrhage (APH)                   
  • Eclampsia                   
  • Pre eclampsia 
  • Obstructed Labour     
  • Poor progress of labour          
  • PIH
  • Ruptured uterus
  • Cord Prolapse              
  • Failed induction
  • Retained Second Twin          
  • Elderly primip Gravida          
  • High head/big baby/big abdomen      
  • Vaginal fibrosis          
  • Delayed first stage     

 

1.1.2Low Birth Weight

Low birth weight rate is a proportion of babies’ birth weight less than 2.5kg. Infants who may be at risk and need special attention are identified by this indicator. The low birth weight occurs as a result of malaria in pregnancy, threatened abortions, aneamia among others. Prevention and management of malaria is on-going in the region through case Management, use of IPT, ITNs Health education and promotion. Registrants of babies with birth weight less than 2.5kg were 6066 (9%).

 

1.1.3Still Birth

The region recorded 1,032 for the year 2016 a coverage of 1.50% as against 1.70% for the year 2015.Fresh stillbirth and macerated during the year under review accounted for 397 and 635 respectively.

Most of the still births recorded were caused by the following;

 

  • Macerated
  • Cord around neck
  • Prematurity
  • Cord prolapsed
  • Herbal preparation as for enema
  • Severe asphyxia
  • Delayed 2nd stage
  • Malpresentation
  • Intrauterine death
  • Hydrocephalus
  • Abruption placenta
  • APH
  • Ruptured uterus         
  • Foetal distress
  • Anencephaly

 

 

1.1.4Maternal death

Seventy six (76) institutional maternal deaths were recorded given a ratio of 117.1/100,000LB. Table 6.5 shows the trend of maternal deaths in the region from 2012 – 2016.

Table 6.5: Maternal Deaths in Brong Ahafo Region 2012 - 2016

Year

No. of Deaths

MMR per 100,000LB

2012

109

164.9/100,000LB

2013

95

138.7 /100,000LB

2014

95

134.9 /100,000LB

2015

87

130.6 /100,000LB

2016

77

117.1/100,000LB

 

 

Causes of Maternal Deaths

 

Direct Causes

 

  1. Haemorrhage
  • PPH……………………. ……………11
  •  
  • Ruptured uterus……………………….1

 

  1. PIH/Eclampsia………………………            5         
  2. Unsafe abortion (sepsis) …………….…        8
  3. Ectopic gestation …………………..             1

 

Indirect Causes

  • Severe anaemia………….                              1
  • Pulmonary  embolism………….                     4
  • Hypovolaemic shock…………..                     2
  • Sickle cell crises……………….                     2
  • Cardiac arrest …………………                   6
  • Respiratory failure…………….                   4
  • Hypertension disease………….                    10

 

Others

  • HIV/TB…………………………                   1         
  • Systemic poison ……………….                  1
  • Trauma …………………………                 1
  • DKA……………………………                   1
  • Multiple organ failure ……….....                 1
  • Meningitis ………………………                 2

 

Major causes of maternal death for the year 2016 were as follows:

 

  1. Haemorrhage………………….   27
  2. Hypertension disease …………   10
  3. Septicemia………………………  8
  4. Cardiac arrest …………………    6

 

Table 6.6: Maternal Death and Audit. 2016

 

 

 

District

Total maternal deaths 2016

Maternal deaths audited 2016

Dormaa East

1

1

Kintampo North

1

1

Tain

1

1

Jaman South

2

2

Sene West

2

2

Tano North

2

2

Tano South

2

2

Asunafo North

3

3

Atebubu-Amanten

3

3

Dormaa Municipal

3

3

Nkoranza South

4

4

Pru

4

4

Berekum

8

8

Sunyani Municipal

20

20

Techiman Municipal

21

21

TOTAL

77

77

 

1.1.1Abortions and Post Abortion Care

A number of 5,341 abortion cases were recorded from which 1515 were induced, 2,801 were spontaneous and 1025 were elective. MVA done for the year 2016 was 3245; D&Cs performed were 1,497. Post abortion care counseling given was 5,456 out of which 3,818 accepted family planning of various kinds while 374 fistula cases were seen with 5 referred.

 

Type of abortions

2012

2013

2014

2015

2016

Spontaneous

2,396

2,549

2,662

2,628

2,801

Induced

1,950

2,070

2,211

2,126

1,515

Elective

143

319

386

705

1,025